tbuckley/cabot-search huggingface dataset:
Abstract 12744: Outcomes of Patients With Myeloproliferative Neoplasms Admitted for Myocardial Infarction: Insights From National Inpatient Sample
Authors: Orly Leiva, Emaad A Siddiqui, Andi Mai, Jiachen Li, Ambar Caba-Urena, Gabriela Hobbs, Sripal Bangalore
Journal: Circulation (2022)

Introduction: Myeloproliferative neoplasms (MPNs) are chronic clonal stem cell neoplasms with high risk of thrombosis and cardiovascular events. However, outcomes after acute myocardial infarction (AMI) and risk factors for cardiovascular events after AMI in patients with MPN have not been well characterized. Methods: Adult patients with a primary admission of AMI from September 2015 to December 2018 (N = 699,786) with (N = 3,156) and without (N = 696,586) a diagnosis of MPN were identified using the National Inpatient Sample. Primary outcome was composite inpatient major adverse cardiac events (MACE) of arterial and venous thrombosis, non-fatal cardiac arrest, and mortality. Patients with and without MPN were compared using propensity score estimation using Generalized Boosted Models(GBM). Outcomes between groups were compared using multivariable logistic regression. Results: Patient characteristics are described in Table 1. Patients with MPN were more likely to have a history of heart failure and less likely to have a history of coronary artery disease compared with patients without MPN. Patients with MPN were less likely to undergo revascularization despite similar rates of STEMI. After propensity score weighting with GBM and multivariable logistic regression, MPN patients had increased risk of MACE, arterial thrombosis, VTE and bleeding (Figure). Conclusions: Among patients hospitalized with AMI, those with MPN are at increased risk of MACE compared with patients without MPN. Revascularization is less utilized in patients with MPN. More investigation is needed in order to improve post-AMI outcomes in patients with MPN.
Abstract 14886: Utilization Patterns and Outcomes of Home Health Care After Coronary Artery Bypass Grafting
Authors: Mike P Thompson, Hechuan Hou, Donald S Likosky, Francis D Pagani, Jason Falvey, Kathy Bowles, Madeline R Sterling
Journal: Circulation (2022)

Introduction: Home health care (HHC) use after discharge may improve short-term outcomes and reduce expenditures for patients undergoing coronary artery bypass grafting (CABG), but there is limited data describing utilization patterns of HHC and its association with longer-term outcomes. Thus, we investigated the utilization patterns of HHC and its impact on 1-year outcomes among Medicare beneficiaries who underwent CABG. Methods: Medicare beneficiaries undergoing CABG between July 2016 and December 2018 were identified using 100% Medicare files. Beneficiaries were excluded if they were &lt;65 years old, died during the inpatient stay, or used inpatient post-acute care before or after the index procedure. Use of HHC (yes versus no) was defined as the presence of a home health claim within 0-1 days of discharge. Clinical outcomes included 1-year mortality and all-cause readmission. We created a matched sample using a multivariable probit regression model (1:1) and balanced HHC users to non-users by demographic, clinical, and hospital factors to compare clinical outcomes. Results: Among the 91,166 beneficiaries in our sample, 54,169 (59.4%) used HHC after discharge, and were more likely to be older, female, White, have dual-eligibility status, comorbid, have had a non-elective, a concomitant valve procedure, and longer hospital length of stay. With respect to hospital characteristics, HHC users were more likely to be admitted to hospitals that were major teaching, larger bed size, not-for-profit, and not system-affiliated. Use of HHC varied from 0% to 100% across 976 hospitals, with a median of 66.2% (IQR=44.2%). After matching and adjustment for covariates, there was no significant difference in 1-year mortality among HHC users and non-users (2.2% vs. 2.5%, -0.3%, p=0.029), although 1-year readmission rates were 7.9 percentage points higher (29.4% vs. 21.5%, p&lt;0.001) for HHC users vs. non-users. Conclusions: Over half of Medicare beneficiaries undergoing CABG used HHC after discharge, with significant differences across patients and hospitals and mixed impact on clinical outcomes. While unmeasured severity may account for some of our findings, more research is needed to understand utilization patterns and impact of HHC after CABG.
Abstract 13449: Patient-Triggered Symptomatic Events Poorly Predict Presence of Atrial Arrhythmia on Ambulatory Electrocardiogram Monitors in Heart Failure Patients
Authors: Maranda Herner, Zameer Abedin, Michael Torre, yue Zhang, Cody Orton, Ann Lyons, Ryan Butcher, Benjamin A Steinberg
Journal: Circulation (2022)

Introduction: Emerging evidence supports more aggressive rhythm control of atrial fibrillation (AF) among heart failure (HF) patients. Yet, the impact of AF on symptom status in HF and the relationship to rate control have not been well studied in the setting of prolonged, ambulatory monitoring. Hypothesis: Patient-triggered symptomatic events (PTSEs) can predict the simultaneous presence of atrial tachycardia/AF (ATAF) on cardiac event monitors(CEM) among HF patients with documented atrial arrhythmia. Methods: All UHealth HF patients with at least 1 ATAF event over ≥7 days on CEMs were retrospectively reviewed. Tetrachoric correlation analysis between PTSEs and ATAF events and t-tests of mean heart rates(HR) were performed. Results: A total of 3,162 events were analyzed among 185 HF patients. The mean age was 68 years and 43% were female; 61% had CAD; the mean ejection fraction was 54% (SD 16%); and 74% were on beta-blockers. There were 2347 ATAF events, 1031 PTSEs, and 216 symptomatic ATAF events. Of PTSEs, 21.0% were ATAF, and of ATAF events, 9.2% were symptomatic. Overall mean HR of PTSEs was 94bpm (SD 29), lower than asymptomatic events, 103bpm (SD 29, p&lt;0.001). Mean HR of symptomatic ATAF events was 117bpm (SD 35), compared with asymptomatic ATAF (110bpm, SD 31, p=0.008). See Figure 1. PTSEs were less likely to predict simultaneous ATAF compared to sinus rhythm, with a moderate inverse tetrachoric correlation of -0.69 (bootstrapped 95% CI -0.65, -0.72). Conclusion: Among patients with AF &amp; HF, symptoms are a poor marker of atrial arrhythmia. PTSEs on ambulatory monitoring are not correlated with ATAF events in a clinically meaningful association and are not adequately explained by the heart rate differences. Classic symptom-based treatment of AF and HF should give way to more comprehensive quality-of-life and substrate guides for therapy.
Abstract 13134: Weight Neutral Intervention Improves Metabolic Syndrome Status in Family Caregivers
Authors: Jennifer K Frediani, Melinda K Higgins, Brittany N Butts, Rebecca Gary, Kenneth Hepburn, Sandra B Dunbar
Journal: Circulation (2022)

Introduction: Weight neutral approaches to obesity management may be more effective than traditional weight loss programs. Weight neutral approaches include self-esteem improvement, intuitive eating, and sustainable physical activity (PA) and can reduce cardiometabolic markers without significant weight loss. Hypothesis: We hypothesize that psychoeducation plus exercise intervention will improve cardiometabolic biomarkers related to metabolic syndrome (MetS). Methods: This secondary data analysis from a randomized controlled intervention trial of sedentary family care givers aimed to improve perceptions of caregiving and physical function. A subgroup of the original trial was studied: the psychoeducation group (PE) and psychoeducation plus exercise (PE+EX) groups and those that had blood glucose above 90 ng/dL. The PE group received printed and video instructions of stretching and a 4-week self-care intervention. The PE+EX group received the same plus a 12-week aerobic and resistance PA program. Measurements were at baseline (BL) and 6 months. Univariate comparisons between treatment groups at 6 months were reported. Results: Participants (n=74) had a mean age of 57 years, 87% female, 74% Black, 69% were college educated, mean body mass index (BMI) of 32.3 kg/m2 at BL which did not change significantly by 6m (BMI 32.1, paired t-test p=0.186). Of the 23 that had MetS at baseline in the PE group, 13 (57%) no longer had MetS at 6 months and 2 (13%) worsened. In the PE+Ex group, 12 of the 18 (68%) no longer had MetS at 6 months and 3 (17%) worsened. Overall, there was a positive change in MetS status between BL and 6 months (McNemar’s p&lt;0.001). Of all MetS components, waist circumference (WC) showed significant improvement (14.8% with at risk waist circumference improved, p=0.021). Overall, 39 of 74 (53%) decreased their MetS risk by 1-3 factors from BL to 6 months (Wilcoxon, p&lt;0.001). There was no significant difference between the groups (p=0.358). Conclusions: We conclude that a psychoeducation intervention either alone or with an exercise component showed improvement in MetS status. Future studies should design weight neutral interventions with the intent on changing behavior around diet and exercise combined.
Abstract 14294: Patients With Chronic Kidney Disease Have a Lower Odds of Ventricular Tachycardia Than General Population
Authors: Anton Mararenko, Abbas Alshami, Ndausung Udongwo, Steven Douedi, Viraaj Pannu, Mihir Odak, Eran Zacks
Journal: Circulation (2022)

Introduction: Monomorphic ventricular tachycardia (VT) often results from scar formation secondary to chronic ischemia or myocardial infarction. Microvascular disease is a known risk factor for myocardial dysfunction as it can lead to focal scar formation and thus increase the risk for VT. Chronic kidney disease (CKD) is characterized by microvascular dysfunction on the basis of animal studies through metabolic, endocrine, and immune pathways and therefore was suspected to be a risk factor for developing VT. Methods: We conducted a retrospective cohort study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with VT based on stage of CKD. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant. Results: A total of 456,925 patients were identified based on the inclusion and exclusion criteria above. The number of patients that had VT with and without CKD was 163,760 (3%) and 293,165 (1%), respectively. However, after an adjusted analysis was performed we discovered that the odds ratio of VT in patients with CKD was 0.735 (95% CI 0.720-0.751). Conclusions: In our retrospective cohort study, patients with CKD were found to have a lower risk of developing VT. This is suspected to be due to electrolyte derangements, such as hyperkalemia and hypermagnesemia, commonly seen in these patients and thus creating a cardioprotective electrolyte balance.
Abstract 12797: Obesity Predisposes Pediatric Cancer Patients Treated With Anthracyclines to Subclinical Cardiac Dysfunction Detectable by Strain Echocardiography
Authors: Ian A George, BriAnna Souder, Amy Berkman, David Noyd, Michael J Campbell, Piers Barker, Michael Roth, Michelle HILDEBRANDT, Kevin C Oeffinger, Andrew P Landstrom, Andrew McCrary
Journal: Circulation (2022)

Introduction: Anthracyclines are used in &gt; 60% of pediatric cancer cases yet are associated with a life-long risk of cardiomyopathy. Strain echocardiography is currently the standard of care for cardiac surveillance in adult cardio-oncology. However, strain has yet to be widely evaluated in the pediatric population. Hypothesis: Strain analysis on echocardiograms from anthracycline-exposed pediatric patients will identify dysfunction that is overlooked by left ventricular ejection fraction (LVEF) alone and which will be associated with identifiable cardiovascular risk factors. Methods: All anthracycline-exposed cancer patients &lt; 18 years old with an initial visit to Duke University between 2013-2019 were identified. Subjects with cancer relapses, congenital heart disease, or inadequate imaging for analysis were excluded. Peak longitudinal left ventricular strain was calculated from the 4-chamber view on all adequate surveillance studies for each patient using the TOMTEC AutoSTRAIN software. Univariate and multivariate Cox proportional hazards models were created to identify risk factors for abnormal LVEF (&lt;50%) or abnormal longitudinal strain (&gt;-16%). Results: The cohort included 101 subjects (52% male) with 606 echocardiograms for analysis. Median age at diagnosis was 12 years (IQR = 3-15), and median anthracycline dose was 201 mg/m 2 (IQR = 120-284). Median follow-up duration was 3.7 years (IQR = 2.3-5.3). Abnormal LVEF was identified in 5 subjects, while abnormal strain was identified in 16 subjects. All subjects with abnormal LVEF also had abnormal strain. When adjusting for dose, BMI, and family history of cardiovascular disease, anthracycline dose &gt; 250 mg/m 2 and BMI &gt; 25 at diagnosis were predictors of abnormal strain with hazards ratios of 3.3 (p =.02, CI = 1.2-8.9) and 3.2 (P = .03, CI = 1.1-9.5), respectively. Anthracycline dose was the only significant predictor of abnormal LVEF. Conclusions: Longitudinal strain is more sensitive than LVEF alone in identifying subclinical cardiac dysfunction in pediatric cancer patients, and those with a BMI &gt; 25 at diagnosis are at an increased risk of dysfunction. Multi-center studies should further explore the link between obesity, early subclinical dysfunction, and subsequent cardiomyopathy.
Abstract 13533: Communication With Family Caregivers is Beneficial for Improving Health-Related Quality of Life in Patients With Heart Failure
Authors: Misook L Chung, Terry A Lennie, Jennifer Miller, Geunyeong Cha, Debra K Moser
Journal: Circulation (2022)

I ntroduction: Supportive relationships within dyad members involved in heart failure (HF) self-management are beneficial in improving the outcomes of patients. Perceived control over a health condition and depressive symptoms are known to affect health-related quality of life (QoL). Little is known about how mutual support enhances health-related QoL in patients with HF. The purpose of this study was to examine the association between supportive relationship and QoL and whether the association is mediated by perceived control and depressive symptoms in patients with HF. Methods: A total of 155 patients with HF (mean age = 60 years, 65% male, 77% married) completed questionnaires including supportive relationships in communication, decision-making, and reciprocity (Shared Care Instrument [SCI]), perceived control (Control Attitude Scale-Revised), depressive symptoms (Patients Health Questionnaire), and QoL (Minnesota Living with HF). A parallel mediation model was conducted adjusted for age, sex, and functional status (Duke Activity Status Index). Results: Decision-making and reciprocity were not associated with QoL directly and indirectly through the two mediators. Communication was also not directly associated with QoL (Figure 1), but was indirectly related through perceived control (indirect effect = -.177, 95% CI -.288 to -.004) and depressive symptoms (indirect effect = -.576, 95% CI -.883 to -.310). It means that patients who were highly communicative with family caregivers were more likely to have better QoL because of increased perceived control over health conditions and decreased depressive symptoms. Conclusion: HF management involves interdependent interactions between patients and family caregivers. The findings suggest that the use of supportive communication strategies to increase perceived control and depressive symptoms between dyad members in HF management may be beneficial in improving the quality of life in patients with HF.
Abstract 14162: An Observational Study of Guideline-Directed Medical Therapy Optimization for Patients With Heart Failure With Reduced Ejection Fraction in Telehealth versus In-Person Visits
Authors: Parth A Shah, Matthew Almonte, Spencer Carter, Leiandie Hulet, May Xac, Nicholas Hendren, Alpesh Amin, Sandeep R Das
Journal: Circulation (2022)

Introduction: Rates of initiation and dose optimization of guideline-directed medical therapy (GDMT) for heart failure patients with reduced ejection fraction are suboptimal nationally. Recently, virtual medicine has been studied as a potential solution to help overcome barriers limiting GDMT optimization. We evaluated GDMT optimization during telehealth visits compared with in-person visits at Parkland Health, a large urban safety-net health system. Methods: Parkland has a registry of all patients with an ejection fraction ≤ 40% on transthoracic echocardiography within the last three years. Using this registry data of patients seen in the Parkland cardiology clinic between September 2021 and February 2022, we compared GDMT prescriptions for patients before and after each clinic visit. We defined an optimization event as the initiation of a new class of GDMT, a switch to an angiotensin receptor/neprilysin inhibitor, or an increase in dosage of any class of GDMT. The rise of Omicron variant COVID-19 cases in Dallas led to a nearly universal shift of in-person to virtual visits in December 2021, allowing us to compare GDMT optimization rates between each visit type. Results: From 9/12/21 to 12/24/21, there were 147 visits of which 134 (91%) were in-person. Of these in-person visits, 58.2% led to an optimization event. From 12/25/21 to 2/12/22, there were 97 visits of which 84 (89%) were telehealth visits, all conducted by telephone. Of these telehealth visits, 16.1% led to an optimization event (p&lt;0.001). Baseline characteristics of patients from each period were not significantly different (Table 1). Conclusion: Our study demonstrated GDMT optimization was significantly lower in telephone visits compared with in-person visits despite each group having similar demographics and medical co-morbidities. This observation should raise concern over increased reliance on telephone-only encounters, especially in urban resource limited populations.
Abstract 13353: Association of Plasma Metabolites With Inflammatory Markers CRP and GlycA and Their Responses to Exercise Training
Authors: William G Hoffmann, Jacob L Barber, Prasun Dev, William A Clarkson, Guoshuai Cai, Prashant Rao, Michael Mi, Daniel H Katz, Sujoy Ghosh, Clary Clish, Jeremy M Robbins, Claude Bouchard, Robert E Gerszten, Mark A Sarzynski
Journal: Circulation (2022)

Introduction. C-reactive protein (CRP) and GlycA are established biomarkers of inflammation. Regular exercise tends to decrease CRP and GlycA levels. However, the spectrum of molecules associated with the anti-inflammatory effects of regular exercise are less well understood. Hypothesis. We hypothesized that distinct metabolite signatures exist for both baseline levels and exercise responsiveness of CRP and GlycA. Methods. Measures were performed before and after 20 weeks of endurance exercise training in 652 Black and White adults from the HERITAGE Family Study. A total of 300 targeted plasma metabolites were measured using LC-MS. High-sensitivity CRP and GlycA were measured using automated assays and NMR spectroscopy (LabCorp), respectively. Linear mixed models were used to test: 1) Association of baseline metabolites with baseline hsCRP and GlycA and 2) Association of changes in metabolite with changes in hsCRP and GlycA. Models were adjusted for age, sex, race, BMI, with family membership as a random variable, with change models also adjusting for baseline trait value. Significance was determined as FDR&lt;0.05. Results. Baseline levels and changes of hsCRP and GlycA were moderately correlated (r=0.51 and 0.31, p&lt;0.0001 for both, respectively). At baseline, 40 and 94 metabolites were associated with hsCRP and GlycA, respectively, with 30 metabolites associated with both phenotypes. The top baseline associations for both traits included multiple species of lysophosphatidylcholine (LPC) and phosphatidylethanolamine (PE), while cortisol, biliverdin, and bilirubin were among the metabolites associated with GlycA only. The changes in only one metabolite were associated with concomitant changes in CRP, while no associations were found for change in GlycA. Conclusions. Plasma metabolite associations with baseline hsCRP overlapped with those associated with baseline GlycA levels. Several unique metabolite associations with baseline GlycA were identified, including molecules in established inflammatory pathways. Metabolite changes with exercise were not associated with changes in either measure. These findings have implications for the use of metabolites as signatures of systemic inflammation vs as targets of lifestyle interventions.
Abstract 14215: Higher Social Vulnerability is Associated With Lower Self-Care Monitoring in African Immigrants With Chronic Disease
Authors: Onome H Osokpo, Christin Iroegbu, Liming Huang, Lisa M Lewis, Karen Hirschman, Mary D Naylor, Barbara J Riegel
Journal: Circulation (2022)

Background: Self-care is important in chronic illness management. While known that social determinants of health or social vulnerability (SV) influence health outcomes, little is known about the influence of SV on self-care and less is known about how SV influences self-care among African immigrants with chronic Cardiovascular disease (CVD). Therefore, we examined the relationship between individual-level SV and self-care in this population. Method: Self-identified African immigrants with symptomatic chronic CVD, over age 35 years, who spoke and understood English were enrolled in this descriptive, cross-sectional study (n=128). Individual SV scores were calculated based on gender, marital status, education, English proficiency (speaking and understanding), race, income, employment, living condition, immigration status, health insurance, and healthcare access; possible SV 0-12. Higher scores, higher social vulnerability. Self Care of Chronic Illness Inventory measured self-care maintenance, monitoring, and management (scores standardized 0-100, ≥70 adequate self-care). Multivariable linear regression was used to assess the association of SV with self-care, adjusting for age and duration of US residency. Results: The sample was mostly older adults (56±11 years), 68% men, 70% married, 82% college educated, 89% living with family or others, with a long duration of residency (16±11 years). Most common illnesses were hypertension (48%) and/or diabetes (20%). Self-care scores were adequate (maintenance=78.7, monitoring=79.3, management=73.9). SV score (3.49±2.03). Higher SV was associated with lower self-care monitoring (p=0.04) but not with self-care maintenance or management. Conclusion: Self-care monitoring was the only dimension of self-care associated with SV. African immigrants who feel more socially vulnerable may focus on monitoring to avoid needing acute care. Culturally tailored interventions focused on self-care monitoring may help this population follow a reliable method in detecting significant changes in signs and symptoms.